Provider Coder Compliance Specialist

Under the guidance of the Manager Corporate Compliance and Privacy or Chief Compliance Officer and the Corporate Compliance Director/Privacy Officer the Provider coding compliance specialist. assist in coordinating all aspects of the Corporate Compliance program in the provider space. Is responsible for performing job duties in accordance with the mission, vision, and values of Tampa General Hospital.

Essential Functions:

• Effectively identify, validate and ensure corporate compliance for providers through evaluation of billing patterns and routine audits.
• Track Provider coding audit results, pass rates, and training. Provide quarterly spreadsheets and reports to management.
• Acts has a liaison for the Corporate Compliance and Privacy department with stake holders and vendors throughout the enterprise.
• Completes provider claims audit review and summary.
• Completes claims audits associated with due diligence. Reviews clinical documentation for accuracy for billing and claims audits.
• Identify potential compliance risks and vulnerabilities within the organization's operations.
• Performs research on various compliance topics, including for example new and existing regulations, best practices and assess implications on the company.
• Researches and provides feedback related to provider regulatory inquiry.
• Develops training materials and monitoring tools for provider education based on audit finding and regulatory guidance.
• Monitors all operational processes and procedures using a compliance management platform to ensure that the company complies with all legal regulations and ethical standards.
• Maintain records, reports, and documentation related to compliance activities.
• Continue knowledge building of federal and state regulations governing the healthcare industry, developing and coordinating educational programs on elements of compliance.

Qualifications:

• Minimum of three (3) years of coding and auditing experience; knowledge of and working experience in professional billing with an associate’s degree. 
• Certified Professional Coder or Certified Coding Specialist certification required upon Hire. 
• Certified Healthcare Compliance certification within 18 months of hire. 
• An equivalent combination of education and years of experience.